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Neoadjuvant TDM1 With Lapatinib and Abraxane Compared With Trastuzumab Plus Pertuzumab With Paclitaxel (TEAL)

This study is currently recruiting participants. (see Contacts and Locations)
Verified September 2016 by The Methodist Hospital System
Celgene Corporation
The Methodist Hospital System
Information provided by (Responsible Party):
Jenny C. Chang, MD, The Methodist Hospital System Identifier:
First received: February 18, 2014
Last updated: September 12, 2016
Last verified: September 2016

Purpose: The purpose of this study is to evaluate the Pathological Complete Response (pCR) of the breast when trastuzumab emtansine (TDM-1) plus Lapatinib plus Abraxane is combined in newly diagnosed HER2 positive breast cancer.

This is a randomized, open label Phase II neo-adjuvant study comparing the efficacy of neoadjuvant Trastuzumab Emtansine (TDM1) plus lapatinib follow by Abraxane, versus trastuzumab (herceptin) plus Pertuzumab follow by paclitaxel.

Condition Intervention Phase
Breast Cancer
Drug: Trastuzumab Emtansine
Drug: Trastuzumab
Drug: Lapatinib
Drug: Abraxane
Drug: Paclitaxel
Drug: Pertuzumab
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Randomized Open Label PhII Trial of Neoadjuvant Trastuzumab Emtansine (Te) in Combination w/Lapatinib (L) Followed by Abraxane (A) Compared w/Trastuzumab Plus Pertuzumab Followed by Paclitaxel in Her 2 Neu Over-Expressed Breast Cancer Patients

Resource links provided by NLM:

Further study details as provided by The Methodist Hospital System:

Primary Outcome Measures:
  • pathological complete response rate (pCR) [ Time Frame: From date of randomization until the date of surgery, approximately 16 weeks ] [ Designated as safety issue: Yes ]
    To evaluate the pathological complete response rate (pCR) in the breast after treatment with Trastuzumab Emtansine plus Lapatinib follow by Abraxane in women with HER2 Neu over-expressed breast cancer patients.

Secondary Outcome Measures:
  • Clinical Response Rate [ Time Frame: From date of randomization until completion of neoadjuvant treatment, approximately 16 weeks ] [ Designated as safety issue: No ]
    To determine the clinical response rate in patients with palpable disease.

  • breast imaging response to treatment [ Time Frame: approximately 16 weeks ] [ Designated as safety issue: No ]
    To determine the imaging response to neoadjuvant therapy through breast imaging (mammogram, ultrasound and MRI) using RECIST.

  • objective response rate [ Time Frame: approximately 16 weeks ] [ Designated as safety issue: No ]
    To compare overall objective response rate in both treatment groups.

  • toxicity, safety and efficacy of study treatment [ Time Frame: approximately 16 weeks from randomization ] [ Designated as safety issue: Yes ]
    To assess toxicity, safety and efficacy of Trastuzumab Emtansine when combine with Lapatinib follow by Abraxane

Other Outcome Measures:
  • determine predictive markers [ Time Frame: approximately 1 year ] [ Designated as safety issue: No ]
    To determine predictive markers for sensitivity and resistance to Trastuzumab Emtansine when combined with Lapatinib follow by Abraxane

Estimated Enrollment: 30
Study Start Date: February 2014
Estimated Study Completion Date: June 2017
Estimated Primary Completion Date: June 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: TDM1 with Laptinib followed by Abraxane
Trastuzumab Emtansine IV every three weeks plus Lapatinib oral daily for a total of six (6) weeks followed by Abraxane IV weekly for twelve (12) weeks.
Drug: Trastuzumab Emtansine
trastuzumab emtansine [Kadcyla] Intravenous repeating dose every 3 weeks
Other Names:
  • TDM1
  • Kadcyla
Drug: Lapatinib
Lapatinib repeating dose taken orally every day for 6 weeks
Other Name: tykerb
Drug: Abraxane
Abraxane repeating dose weekly IV for up to 12 weeks
Active Comparator: Herceptin plus Pertuzumab followed by paclitaxel
Trastuzumab (Herceptin) IV weekly plus Pertuzumab IV for a total of six (6) weeks, followed by weekly IV paclitaxel for twelve (12) weeks.
Drug: Trastuzumab
Trastuzumab (Herceptin) Intravenous repeating dose weekly
Other Name: Herceptin
Drug: Paclitaxel
Paclitaxel IV repeating dose weekly for up to 12 weeks
Drug: Pertuzumab
Pertuzumab repeating dose weekly IV for up to 12 weeks
Other Name: Perjeta


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Female gender;
  • Age ≥18 years;
  • Performance Status- Eastern Cooperative Oncology Group (ECOG) 0-1
  • Histologically confirmed invasive breast cancer:
  • Primary tumor greater than 1 cm diameter, measured by clinical examination and mammography or ultrasound.
  • Any N,
  • No evidence of metastasis (M0) (isolated supra-clavicular node involvement allowed);
  • Over expression and/or amplification of HER2 in the invasive component of the primary tumor and confirmed by a certified laboratory prior to randomization.
  • Known hormone receptor status.
  • Hematopoietic status:
  • CBC not less than .75 of institutional lower limit. Absolute neutrophil count ≥ 1,5 x 10^9/L, Platelet count ≥ 100 x 10^9/L, Hemoglobin at least 9 g/dl,
  • Hepatic status:

Serum total bilirubin ≤ 2 x upper limit of normal (ULN). In the case of known Gilbert's syndrome, a higher serum total bilirubin (< 1.5 x ULN) is allowed, Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) ≤ 3.5 times ULN, Alkaline phosphatase ≤ 2.5 times ULN, • Renal status: Creatinine ≤ 1.5mg/dL,

• Cardiovascular: Baseline left ventricular ejection fraction (LVEF) ³ ≥50% measured by echocardiography (ECHO) or Multiple Gate Acquisition (MUGA) scan,

  • Negative serum or urine β-hCG pregnancy test at screening for patients of childbearing potential within 2-weeks (preferably 7 days) prior to randomization.
  • Fertile patients must use effective contraception (barrier method - condoms, diaphragm - also in conjunction with spermicidal jelly, or total abstinence. Oral, injectable, or implant hormonal contraceptives are not allowed)
  • Signed informed consent form (ICF)
  • Patient accepts to make available tumor samples for submission to central laboratory to conduct translational studies as part of this protocol.

Exclusion Criteria:

  • Previous (less than 5 years) or current history of malignant neoplasms, except for curatively treated: Basal and squamous cell carcinoma of the skin; Carcinoma in situ of the cervix.
  • Patients with a prior malignancy diagnosed more than 5 years prior to randomization may enter the study.
  • Preexisting peripheral neuropathy ≥ grade 2
  • Known history of uncontrolled or symptomatic angina, clinically significant arrhythmias, congestive heart failure, transmural myocardial infarction, uncontrolled hypertension (≥180/110), unstable diabetes mellitus, dyspnea at rest, or chronic therapy with oxygen;
  • Concurrent disease or condition that would make the subject inappropriate for study participation or any serious medical disorder that would interfere with the subject's safety;
  • Unresolved or unstable, serious adverse events from prior administration of another investigational drug;
  • Dementia, altered mental status, or any psychiatric condition that would prevent the understanding or rendering of ICF;
  • Malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel. Subjects with ulcerative colitis are also excluded;
  • Concurrent neoadjuvant cancer therapy (chemotherapy, radiation therapy, immunotherapy, biologic therapy other than the trial therapies);
  • Concurrent treatment with an investigational agent or participation in another therapeutic clinical trial;
  • Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to trastuzumab Emtansine, trastuzumab, lapatinib, paclitaxel, abraxane or their components;
  • Pregnant or lactating women;
  • Concomitant use of CYP3A4 inhibitors or inducers
  • Other concurrent severe and/or uncontrolled concomitant medical conditions (e.g. active or uncontrolled infection, uncontrolled diabetes) that could cause unacceptable safety risks or compromise compliance with the protocol
  • Patients have an active infection and require IV or oral antibiotics.
  • Pregnant or breast-feeding women
  • Patients unwilling or unable to comply with the protocol
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT02073487

Contact: Houston Methodist Cancer Center 713-441-0629

United States, Texas
Houston Methodist Hospital Recruiting
Houston, Texas, United States, 77030
Contact: Houston Methodist Cancer Center    713-441-0629   
Sub-Investigator: Angel A Rodriguez, MD         
Sub-Investigator: Daniel Lehane, MD         
Sub-Investigator: Tejal Patel, MD         
Sub-Investigator: Monisha Singh, MD         
Sub-Investigator: Jorge Darcourt, MD         
Houston Methodist Hospital Willowbrook Recruiting
Houston, Texas, United States, 77070
Contact: Houston Methodist Cancer Center    713-441-0629   
Principal Investigator: Anna Belcheva, MD         
Houston Methodist Hospital Sugar Land Recruiting
Sugar Land, Texas, United States, 77479
Contact: Houston Methodist Cancer Center    713-441-0629   
Principal Investigator: Jorge Darcourt, MD         
Sponsors and Collaborators
Jenny C. Chang, MD
Celgene Corporation
The Methodist Hospital System
Principal Investigator: Jenny C Chang, MD The Methodist Hospital System
  More Information

Additional Information:
Responsible Party: Jenny C. Chang, MD, Sponsor-Investigator/Principal Investigator, The Methodist Hospital System Identifier: NCT02073487     History of Changes
Other Study ID Numbers: 1013-0164 
Study First Received: February 18, 2014
Last Updated: September 12, 2016
Health Authority: United States: Federal Government
United States: Food and Drug Administration
United States: Institutional Review Board

Keywords provided by The Methodist Hospital System:
Neoadjuvant Breast Cancer
HER2 positive Breast Cancer

Additional relevant MeSH terms:
Breast Neoplasms
Neoplasms by Site
Breast Diseases
Skin Diseases
Ado-trastuzumab emtansine
Albumin-Bound Paclitaxel
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Protein Kinase Inhibitors
Enzyme Inhibitors processed this record on October 25, 2016